Journal of the American Geriatrics Society

Use of a Computer-Based Reminder to Improve Sedative–Hypnotic Prescribing in Older Hospitalized Patients

Joseph V. Agostini MD

From the ^* Clinical Epidemiology Research Center, VA Connecticut Healthcare Center, West Haven, Connecticut ^† Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut ^‡ Institute for Aging Research, Hebrew Rehabilitation Center/Hebrew Senior Life, Boston, Massachusetts ^§ Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

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Ying Zhang MD, MPH,

Ying Zhang MD, MPH

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Sharon K. Inouye MD, MPH,

Sharon K. Inouye MD, MPH

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Joseph V. Agostini MD,

Joseph V. Agostini MD

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Ying Zhang MD, MPH,

Ying Zhang MD, MPH

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Sharon K. Inouye MD, MPH,

Sharon K. Inouye MD, MPH

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First published: 16 January 2007

https://doi.org/10.1111/j.1532-5415.2006.01006.x

Citations: 40

Address correspondence to Joseph V. Agostini, MD, Clinical Epidemiology Research Center 151B, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516. E-mail: [email protected]

Presented in part as a poster at the annual meeting of the American Geriatrics Society, Orlando, Florida, May 13, 2005.

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Abstract

OBJECTIVES: To develop a feasible, inexpensive, point-of-care computerized reminder to improve sedative-hypnotic prescribing in hospitalized older people.

DESIGN: Pre-postintervention with a computer-based reminder.

SETTING: Academic medical center.

PARTICIPANTS: Hospitalized patients aged 65 and older.

INTERVENTION: Computer-based reminder directing clinicians to prescribe a nonpharmacological sleep protocol, to minimize the potential for harm with diphenhydramine and diazepam use by choosing an alternative medication (trazodone or lorazepam), or both.

MEASUREMENTS: Frequency of prescription of four sedative-hypnotic drugs (diphenhydramine, diazepam, lorazepam, and trazodone) during the 12 months before (n=12,356 patients) and after (n=12,153) the reminder was instituted.

RESULTS: Prescribing of sedative-hypnotics decreased from 2,208 per 12,356 (18%) patients preintervention to 1,832 per 12,153 (15%) postintervention (odds ratio for the intervention=0.82, 95% confidence interval=0.76–0.87), an 18% risk reduction. Combined prescription rates for all four drugs fell consistently throughout the postintervention period. Diphenhydramine, diazepam, and lorazepam orders declined overall, with lorazepam prescriptions decreasing 39% during the intervention. Ninety-five percent of patients were successfully directed to a safer sedative-hypnotic drug or a nonpharmacological sleep protocol.

CONCLUSION: Using real-time computer-based reminders could lead to improved sedative-hypnotic prescribing for older persons in acute care. This study highlights the potential to address patient safety concerns, and the quality of medication prescribing in particular, in vulnerable hospitalized patients.

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Volume55, Issue1

January 2007

Pages 43-48

Use of a Computer-Based Reminder to Improve Sedative–Hypnotic Prescribing in Older Hospitalized Patients

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Use of a Computer-Based Reminder to Improve Sedative–Hypnotic Prescribing in Older Hospitalized Patients

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